Introduction: treatment gains outpace resources
Across Ireland, the gains in HIV treatment over the past two decades have been life-changing for people living with the virus. Yet many clinicians warn that the public health and community resources supporting prevention, testing and ongoing care have not scaled up in tandem. In areas like Cork and surrounding counties, dedicated HIV services are feeling the strain even as treatment regimens become more effective and easier to manage for patients.
Tara Russell, director at the Cork Sexual Health Centre, has highlighted the shift. While treatment availability has expanded and improved, she notes that the corresponding resources—staff, clinics, testing programs, and community support—haven’t grown at the same pace. The consequence, she suggests, is a gap between what medical advances can offer and what health services can realistically deliver on the ground.
Rising case numbers, flat resources: a troubling trend
Two decades ago, estimates suggest that roughly one hundred people in the counties around Cork lived with HIV. Today, that number is closer to a thousand. This rapid increase places more pressure on HIV testing services, clinics, and prevention programs at a time when funding and staffing levels have not risen proportionally to meet demand. In practical terms, patients may face longer waits for testing, delayed access to new treatment options, and fewer opportunities for prevention services such as PrEP (pre-exposure prophylaxis) and community counseling.
Why the gap persists
Funding and workforce pressures
Public health budgets have faced constant scrutiny, often tightening around competing priorities. HIV services, which rely on a blend of hospital clinics, sexual health centres, and community groups, depend on a steady flow of trained professionals. With workforce shortages, vacancies can linger and delays can accumulate, undermining timely testing, linkage to care, and ongoing support for people living with HIV.
Rural-urban and regional disparities
Access gaps are more pronounced outside major cities. Rural areas frequently lack easy access to specialized HIV care, which can lead to late diagnoses and fragmented care. Telehealth and integrated primary care models offer some relief, but they cannot fully substitute for in-person support, particularly for complex cases that require multidimensional services—from mental health to housing and social support.
What needs to happen now
Boost funding and workforce development
Experts advocate for renewed investment in sexual health services, with targeted funding to recruit and retain clinicians, counselors, and peer workers. Expanded training programs and retention incentives could help sustain a workforce capable of delivering comprehensive HIV care, prevention, and support at scale.
Broaden access to testing and prevention tools
Expanding routine HIV testing in primary care settings, pharmacies, and community venues could improve early detection. Widening access to PrEP and simplifying prescription pathways—especially through primary care and nurse-led clinics—are critical steps to curb new infections and empower at-risk individuals with effective prevention options.
Integrate HIV care into primary health and community services
Integrating HIV management into general practice and sexual health services can reduce fragmentation. Co-locating services—such as HIV care, STI testing, mental health support, and social services—creates a holistic approach that can improve outcomes and reduce the burden on specialized HIV clinics.
A practical, compassionate path forward
While advances in HIV treatment have transformed clinical outcomes, the social and administrative architecture supporting people living with HIV must be strengthened. The goal is not only to prolong life but to improve its quality by ensuring timely diagnosis, easy access to care, robust prevention measures, and a supportive, stigma-free environment. The voices of clinicians like Tara Russell and the communities they serve must guide policy decisions, driving investments that align resources with the reality of rising case numbers and evolving treatment options.
Key takeaways
- Resource scaling must catch up with treatment advances to prevent gaps in care.
- Expanded PrEP access and routine HIV testing are essential prevention strategies.
- Strong investment in workforce and regional access will reduce delays and improve outcomes.
